Pension-Level Supported Residential Services and their Influence in the Occupational Participation and Recovery of Residents with Mental Illness

A Supported
Residential Service (SRS) is a privately owned, government regulated housing
facility. Initially recognised as supported accommodation services for an older
population, Census trends indicate that pension‐level facilities are
increasingly more likely to house residents who are male, younger, and with
psychiatric, intellectual, acquired brain injury, or drug/alcohol disabilities.
The purpose of this research was to understand how the elements of the
physical, social and cultural environment impact occupational participation and
recovery for residents with mental illness to better inform policy and service
provision. A mixed method research design was chosen to provide a comprehensive
analysis of the research question. The Residential Environment Impact Scale
Version (REIS) 3.0 was the research tool used to assess the residential
environment and determine the impact of the environment on the residents.
Convenience samples of three SRS’s were included, with a total of 22 resident
and staff participants interviewed and observed. Quantitative data was
generated by the REIS four point rating scale and scores were compared and
contrasted to establish if there were common or different domains that the
three SRS’s performed well or poorly in. Descriptive data was analysed for
themes. Four themes emerged during this process; opportunities for occupational
participation, impact of the social environment, opportunities for
self-determination and the impact of political and economic environmental
factors. These themes reinforced the domains identified from the raw data
ratings and helped establish that residents shared similar experiences of
enjoyment, stimulation, boredom, time use and goal setting. <br>
Similar qualities attributed to institutional environments
were found. There was a lack of opportunity for occupation due to; the few
objects in the environment, regulations prohibiting participation and staff
prioritising care needs that created time constraints impacting residents’
opportunities for independence and participation. Residents’ time use was
dominated by waiting, eating and smoking. Days were not experienced as
meaningful, rather, the occupations were reported and observed to be a way of
filling in the day. The three SRS’s rated well in the domains of physical space
and peer relationships, suggesting these aspects of the environment were
enabling however they rated poorly in the domains of occupational
participation, social environment related to interactions with staff, and level
of assistance offered and self-determination. It was these aspects of the
environment that predominantly constrained residents’ occupational
participation, and are the areas requiring the greatest attention for
improvement. <br>
This study emphasises the influence of the physical, social
and political environment on occupational participation and recovery for
residents of pension-level SRS’s with mental illness. Overall the pension-level
SRS environment was assessed as a significant negative influence in the
residents’ quality of life that could be argued as having a predominantly
detrimental effect on the opportunity to regain independence, recover and
improve health outcomes for this population. A number of key recommendations
for the pension-level SRS sector are proposed so future service provision can
be in accordance with recovery orientated service principles, and that the
political, economic and environmental influences in this sector support
participation in occupation for residents.